Indigenous Inequalities
Indigenous inequalities are very evident in health. Unfortunately, Indigenous Australians suffer from much worse health problems than the non-Indigenous Australian population. Here are a few key figures to demonstrate the stark inequalities. In 2017, Indigenous children experienced 1.7 times higher levels of malnutrition than non-Indigenous children. Additionally, three in 10 indigenous people who needed to go to a health provider did not go. Indigenous people’s barriers to healthcare frequently include high costs, unavailability of services, the distance from healthcare services and long waiting times.

Another inequality is that 45% of Indigenous people, aged 15 years or over, said they experienced disability, compared to just 18.5% in the non-Indigenous population. Between 2014-2016, Indigenous children aged 0-4 were more than twice as likely to die as non-Indigenous children. In the Northern Territory, Indigenous infant mortality was four times higher than the national rate. Lastly, Indigenous people had to wait 50 days on average for elective surgery compared to 40 days for non-Indigenous people. All this evidence highlights the stark Indigenous inequalities in health, demonstrating the gap that exists in access to key services and educational tools.

Original Closing the Gap Framework

In 2008, the Australian government made a promise to address Indigenous inequalities in a strategy called Closing the Gap. “The Gap” refers to the vast health and life-expectancy inequalities that exist between Indigenous and non-Indigenous Australians. The framework involved seven targets aimed at reducing socio-economic Indigenous inequalities, including many health targets. However, when the government began evaluating the success of the framework, it became clear that there is still a long way to go.

Five of the seven targets remain unmet, with very little evidence of progress in those target areas. The two targets that the Australian government has met were early education and Year 12 completion rates, but the other targets including child mortality, school attendance, literacy and numeracy and employment and life expectancy, have shown little or no improvements. A lot of the discussions around the failure of the framework have surrounded the issue of the lack of Indigenous voices. The Australian government established the framework with no engagement of the local Indigenous people it was seeking to help. It ignored their individual experiences and their local solutions, and instead came up with a one size fits all solution that failed to understand the Indigenous community.

2020 Programme Refresh

Because of the failure of the original Closing the Gap framework to address Indigenous inequalities in health, in July 2020, the government met and agreed upon a new approach. The government believed a refresh and shift in the Closing the Gap framework was necessary. This refresh involved a partnership between all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak organizations. This represents a huge advancement and the first time that an agreement with an aim to improve the lives of Aboriginal and Torres Strait Islander people has actually involved Indigenous people in its localized solutions.

This newly designed framework will embed the cultural determinants and social determinants of health to provide a single, overarching policy framework for Indigenous health. The vision is that Aboriginal and Torres Strait Islander peoples will be able to enjoy long, healthy lives that are centered in culture, with access to services that are prevention-focused, responsive, culturally safe and free of racism and inequity. The framework ensures that Indigenous people are at the center of creating solutions that work for them in their cultures. Alongside this nationwide government framework, other progress is occurring including the implementation of more healthcare services with healthcare officials that actually represent the population. In fact, healthcare services are involving more Indigenous workers and the government is implementing Indigenous-specific healthcare facilities to better cater to Indigenous people’s specific needs.

New Progress

Evidence is beginning to mount showing the positive effects of reducing Indigenous inequalities in health. For example, from 2013 to 2019, the number of Indigenous medical practitioners employed across Australia increased from 234 to 488. Additionally, Indigenous-specific primary healthcare organizations provided 3.7 million episodes of care in 2018-19. Though progress has been slow so far, there are some promising statistics and a renewed government focus that will hopefully start to reduce Indigenous inequalities in health.

– Lizzie Alexander
Photo: Flickr

In 2017, Australia’s medical system was ranked 2nd globally by The Commonwealth Fund. The country scored well on care, efficiency and health outcomes. However, the Australian health care system scored poorly on equity of care across the population.
Those largely affected by the healthcare discrepancy are members of the indigenous community. Australia is working to decrease the inequity in Aboriginal healthcare. 

Health Challenges for the Aboriginal Healthcare

The average lifespan for indigenous Australians is about 71.4 years, which is 10 years lower than the life expectancy of non-indigenous Australians. About two-thirds of the indigenous population die before the age of 65. Only 19% of non-indigenous people die before 65. Indigenous children under the age of four are also twice as likely to die than non-indigenous children. The common issue of chronic disease is a burden across all age groups of the indigenous population. Indigenous peoples are also over twice as likely to struggle with issues such as addiction and diabetes.  

 The National Aboriginal Community Controlled Health Organisation (NACCHO) reports that the problems facing the Aboriginal healthcare system come from five major health concerns. These five health factors are injury, mental disorders (including substance abuse), cardiovascular disease, respiratory diseases and cancer. Many of these major health concerns are considered to be preventable

 Another discrepancy in Aboriginal healthcare is access to maternal health services. In 2016, 40% of indigenous women lived in very remote areas of Australia, where the access to hospitals equipped with a birthing ward is very low. Women were forced to travel long distances in order to access birthing services. The Australian Institute of Health and Welfare cites that access to “culturally appropriate” care is a major barrier to women seeking maternal services. However, the Australian government has taken a new approach to bring healthcare to indigenous Australians.

The Aboriginal Community Controlled Health Services Initiative (ACCHS)

In Australia, healthcare centers operated by the local indigenous community have shown success in providing medical services to the Aboriginal population. ACCHS aims to provide healthcare to indigenous communities in a way that fosters ongoing medical relationships. These relationships between Aboriginal healthcare providers and the Aboriginal community have been 23% more effective in retaining patients when compared to other healthcare centers. NACCHO believes that a major factor in patient retention is that ACCH centers provide a sense of “cultural safety” within its healthcare practices.

In 1970, the first ACCHS was established and, as of the year 2020, over 140 ACCHS centers are now being operated around Australia. ACCHS centers currently address 61% of the healthcare demands of patients in regional communities. The use of ACCHS centers is continuously growing within the Aboriginal population, demonstrating the success of the initiative. Over a span of 24 months, the NACCHO reported an increase of 24,030 patients.

The Future of ACCHS and Indigenous Communities

The ACCHS initiative also provides opportunities for regional and remote Aboriginals to gain entry into the healthcare profession. The census in 2006 reported that 99% of healthcare workers out of all of the Australian medical workers are not of indigenous descent. Over half of ACCHS workers are indigenous, however, many of these workers are non-clinical staff members. NACCHO strives to create pathways for Aboriginal health care workers through the ACCHS centers. These pathways will allow indigenous community members to operate ACCHS centers, potentially increasing the relationship between patients and healthcare providers. 


The Australian government has developed Closing the Gap targets to help decrease the discrepancy of healthcare between indigenous and non-indigenous Australians. The target states that Australia should have equity in Aboriginal healthcare by 2031. The NACCHO and the ACCHS centers are a key factor for Australia to reach the Closing the Gap targets.

– Laura Embry
Photo: Flickr

Indigenous health in Australia
As of 2012, life expectancy for Indigenous Australians was 10 years lower than that projected for non-Indigenous Australians. Between 2008 and 2012, two-thirds of Indigenous deaths occurred before age 65 whereas less than a quarter of non-Indigenous deaths occurred before age 65 during the same time period. In an effort to improve conditions surrounding Indigenous health in Australia, the Australian government launched Closing the Gap in 2008. The goal of Closing the Gap is to improve the lives of indigenous peoples through better healthcare, education and employment opportunities.

Closing the Gap

In 2008, Closing the Gap set six targets for success for pursuing Indigenous health in Australia: 1) close the gap in life expectancy within one generation (by 2031) 2) cut the mortality rate in half for Indigenous children under 5 3) ensured within five years that all Indigenous children had access to early childhood education 4) cut by 50 percent the gap in reading, writing, and numeracy achievements within a decade 5) narrow the gap in dropout rates between Indigenous and non-Indigenous students and 6) reduced the gap in employment outcomes between Indigenous and non-Indigenous populations by 50 percent in 10 years.

Examination of health gaps between Indigenous and non-Indigenous Australians requires a holistic approach. To understand health, socioeconomic factors such as homeownership and education, behavioral drivers like rates of smoking and diet, along with environmental triggers like overcrowding and history of institutionalized discrimination all contribute to the relatively poor health of Indigenous Australians.

According to the Australian Bureau of Statistics, ischemic heart disease was the leading cause of death, accounting for 11.5 percent of total deaths, among Aboriginal and Torres Strait Islander people in 2017.  Data show that Indigenous people in Australia die from cardiovascular disease at 1.5 times the rate of non-Indigenous people. As of 2017, Diabetes mellitus was the second leading cause of death among Indigenous populations in Australia; in fact, Indigenous Australians were four times more likely to have type 2 diabetes as non-Indigenous Australians.

Major Factors of Indigenous Health in Australia

Indigenous Australians struggle significantly more with poverty than non-Indigenous Australians. Less than 50 percent of Indigenous Australians are employed as compared to 75 percent of non-Indigenous Australians. Furthermore, the median equivalized gross weekly household income is $550 for Indigenous and $850 for non-Indigenous peoples. Factors like income affect the quality of food and housing which has direct ramifications on the health of those involved.

Diseases eliminated in the non-Indigenous population such as trachoma, a bacterial eye infection, and rheumatic heart disease persists with “high occurrence” in Indigenous populations. Nearly one-third of Indigenous Australians reported struggling with a chronic respiratory condition in 2012-2013. Compared to non-Indigenous Australians, Aboriginal and Torres Strait Islander people are hospitalized for respiratory complaints at 2.4 times the rate.

Upon arrival in Australia in the late 1700s, European colonization introduced diseases like smallpox to the Indigenous population. Additionally, the assumption of European superiority over Indigenous Australian has impacted Indigenous health in Australia for hundreds of years. Indigenous peoples in Australia did not get the right to vote until 1962 and were not counted in the national census until 1967. Up to 1992, when the High Court of Australia denied the correctness of the term terra nullius (land belonging to no-one), Australia effectively had denied the presence of an Indigenous population pre-European arrival.

Like the USA, Australia pursued aggressive assimilation policies such as the Australian Aborigines Act of 1905 which established the position of Chief Protector to be the legal guardian of each and “‘every aboriginal and half-caste child’ to the age of 16”. This well-established history of separating families has had deleterious effects on Indigenous mental and physical health across generations.

In the 1970s, Indigenous people began to fight back as they established their own councils of leadership, health clinics, and advocacy bodies such as the National Aboriginal Community Controlled Health Organization (NACCHO) in 1975.

The Good News

The 2019 Closing the Gap report issued by the Australian government celebrates the emerging partnerships between states and territories with Indigenous Australians and the Australian government but acknowledges that many of the target goals are not on track. However, steps are being taken. The implementation of the National Indigenous Australians Agency on July 1, 2019, suggests the Australian government is beginning to get serious about improving Indigenous health in Australia.

As Closing the Gap moves into its next phase, it promises to provide increased accountability on both the state and national levels for including Indigenous people in the process and implementation of initiatives. Prime Minister Scott Morrison argues, “The Australian Government is committed to working in genuine partnership with Aboriginal and Torres Strait Islander peoples, a partnership which is critical to progress towards Closing the Gap.”

– Sarah Boyer
Photo: Flickr